Overweight and obesity disproportionately affect racial and ethnic minority and lower income populations, particularly women. An accumulating body of scientific evidence indicates that obesity, sedentary lifestyles, and unhealthy dietary patterns may significantly increase the risk of several major cancer types. Unfortunately however, the efficacy of weight management programs in diverse sociodemographic groups has been mixed. Accumulating scientific evidence demonstrates that electronic health promotion strategies (e-health) may be effective in assisting individuals to make dietary and PA change. While the literature on e-health technologies has blossomed in recent years, comparatively little empirical attention has been directed to the feasibility of utilizing such technologies to promote healthy weight-control behaviors among sociodemographically-diverse women. E-health tools however, can be adapted to meet the specific literacy, cultural, and logistical needs of these populations. What remains unclear however is the extent to which interpersonal assistance (e.g. coaching) is necessary to realize the maximum amount of ehealth system utilization in the target population. This study is a three-year investigation designed to demonstrate the feasibility of designing and implementing an interactive electronic diet and PA monitoring and feedback system (eSolutions) to be implemented in an urban community recreation center. Study procedures will occur in two phases. In Phase 1, we propose to conduct formative research, design the eSolutions system in an iterative software development process, and conduct usability testing of the system among the target population. In Phase 2, we propose to test the feasibility of implementing the tool among approximately 60 overweight adult women in an urban YMCA branch. Participants will be randomly assigned to one of two experimental conditions: 1) self-paced use of the eSolutions system, or;2) a combined program consisting of eSolutions plus a 12-week coached intervention (eSolutions-Plus). We will examine short term outcomes at the end of this 12 week initial phase. Following the initial phase, participants in both conditions will be asked to utilize the eSolutions for an additional 12-week self-paced maintenance phase. During the maintenance phase, half of the participants in both conditions will be randomly assigned to receive monthly telephone calls to remind them to utilize eSolutions and troubleshoot any system difficulties. Assessments (including self-report survey, anthropometric measurements, and the retrieval of eSolutions system data) will be conducted at baseline, 12-, and 24-weeks post-baseline. Primary outcomes will include measures of sustained eSolutions system utilization. Secondary outcomes will include improvement in dietary practices, PA and weight-loss. This study will demonstrate the feasibility of the eSolutions system and will further provide estimates of effect size that will be used to plan a future randomized controlled trial to test this intervention among YMCAs in Massachusetts. This pilot study also provides a basis for demonstrating additional evidence of successful collaboration between the DF/HCC and UMB and will facilitate our ongoing partnership with the network of Massachusetts YMCAs. A.
SPECIFIC AIMS This study responds to an urgent need to develop, test, and implement cancer prevention interventions for physical activity (PA) promotion and weight management, particularly among ethnically diverse and low-income populations.', 2 We hypothesize that electronic health promotion (e-health) strategies may be effectively implemented in weight management interventions conducted among underserved populations. However, an outstanding question concerns whether the provision of interpersonal support is necessary for members of low income and ethnically diverse populations to realize the full benefits of e-health weight management systems. This issue may impact not only program efficacy, but also the potential for sustainability. Thus, the primary aim of the proposed study is to determine the feasibility of developing and implementing an interactive electronic diet and PA monitoring and feedback system (eSolutions) to promote improvements in diet, PA, and weight loss among a lower income, ethnically-diverse population attending an urban community recreation center.
Our specific aims are: 1. To develop eSolutions, an interactive electronic diet and PA monitoring and feedback system for sociodemographically-diverse, low literacy audiences. 1.1. To evaluate the usability of eSolutions among members of the target population. 2. To determine whether there are differential levels of sustained system utilization between two experimental groups: 1) those using eSolutions in a self-paced fashion, compared to 2) those receiving a combined program consisting of eSolutions plus a 12-week coached weight loss intervention (eSolutions-Plus). 2.1. To determine whether monthly telephone support calls (after week 12 of the protocol) promote longer-term eSolutions system utilization. 3. To estimate the extent to which participants receiving e Solutions-Plus have greater shorter and longer-term improvements in diet, PA, and weight loss compared to those receiving eSolutions alone. 3.1 To estimate whether the greatest longer-term improvements (at 96 weeks) in diet, PA, and weight loss/maintenance are found among eSolutions-Plus participants receiving monthly telephone support calls (after week 12 of the protocol).
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